宫颈癌前哨淋巴结及微转移灶检测的临床意义  

Clinical significance of Micrometastasis in sentinel lymph node of cervical cancer

作　　者：李东林[1] 郑艺[1] 杨誉佳[1] 李权[1] 杨炳[1] 孙丽君[1] 

机构地区：[1]遵义医学院附属医院妇产科,贵州遵义563003

出　　处：《中国现代医学杂志》2011年第15期1885-1888,1893,共5页China Journal of Modern Medicine

基　　金：贵州省卫生厅资助项目(No:D-284)

摘　　要：目的探讨宫颈癌前哨淋巴结人乳头状瘤病毒DNAL1片段(HPV-DNAL1)和细胞角化蛋白19mRNA(CK19 mRNA)表达与常规病理学淋巴结转移之间的关系。方法对25例宫颈癌患者运用亚甲蓝示踪法行前哨淋巴结(SLN)检测,盆腔淋巴结进行HE染色病理学检查,同时实时荧光定量PCR(RT-PCR)法扩增检测盆腔淋巴结组织中HPV-DNAL1和CK19 mRNA表达情况,分析与病理学结果之间的关系。结果 25例患者中有24例检出了前哨淋巴结,检出率为96%;6例患者的17个病理学转移的淋巴结中全部检测到HPV-DNAL1和CK19 mRNA双阳性表达,相应的6个未转移淋巴结中HPV-DNAL1和CK19mRNA、HPV-DNA L1、CK19 mRNA阳性淋巴结个数分别是3个、2个和1个;另外18例无病理学转移者的20个前哨淋巴结中,8个淋巴结检测到HPV-DNAL1和CK19mRNA双阳性;10个淋巴结HPV-DNAL1阳性;2个淋巴结表达CK19mRNA。HPV-DNAL1和CK19mRNA双阳性与患者年龄、病程长短、病理学分级、局部病灶大小无关(P>0.05),与淋巴管内瘤栓形成、宫颈间质浸润有关(P<0.05);前哨淋巴结转移病理学检查的准确性为66.7%,灵敏度为46.2%,RT-PCR检测前哨淋巴结转移的准确性是95.8%,灵敏度100%,特异性92.3%。结论宫颈癌淋巴转移的主要前哨淋巴结是闭孔、髂内和髂外淋巴结,盆腔淋巴结HPV-DNA和CK19mRNA的联合检测可能是微转移灶早期检出更准确的预测指标。【Objective】 To investigate the correlationship between the presence of human papillomavirus DNAL1（HPV-DNAL1） and cytokeratin 19 mRNA（CK19 mRNA） in sentinel lymph nodes and histopathologically confirmed metastasis in cervical carcinoma.【Methods】 Twenty-five patients with cervical cancer were injected methylene blue to detect the Sentinel Lymph Node（SLN）,the pelvic lymph node were examined with HE staining and all cases were evaluated with RT-PCR（real time PCR） examination of CK19 mRNA and HPV-DNAL1 gene fragment in pelvic lymph nodes,the correlation between the presence of HPV DNAL1 or CK19 mRNA or HPV-DNAL1 and CK19 mRNA in lymph node and the clinicopathological indices of cervical carcinoma was analyzed.【Results】 SLN were successfully identified in 24（96%） of twenty-five patients,both HPV-DNAL1 and CK19 mRNA were detected in 17 pelvic lymph nodes with 6 patients confirmed lymph nodes metastasis.The positive of CK19 mRNA,HPV-DNAL1,HPV-DNAL1 and CK19 mRNA was 1,2 and 3 in 6 negative pelvic lymph nodes with 6 patients confirmed metastasis,respectively.The positive of HPV-DNAL1 and CK19 mRNA was 8 in 20 sentinel lymph nodes with 18 patients confirmed negative metastasis.The positive lymph nodes of the HPV-DNAL1,CK19 mRNA were 10,2 respectively.When simultaneous expression of HPV-DNAL1 and CK19 mRNA were considered,their expression patterns not related to age,histological grade,tumor size and the disease course（P 0.05）.It was associated with the tumor thrombi within lymphatic vessels and interstitial tumor infiltration of the cervix,were of prognostic value with statistical significance（P 0.05）,and the accuracy rate of SLN histologically confirmed metastases with HE staining was 66.7%,the sensitivity was 46.2%,compared with RT-PCR in the accuracy,sensitivity and specificity was 95.8%,100% and 92.3% respectively.【Conclusion】 The obturator,internal iliac and external iliac lymph nodes are the most vulnerable lymph nodes of metastasis in cervical carcinoma,the detection of HPV

关 键 词：宫颈肿瘤 人乳头状瘤病毒 细胞角蛋白19 淋巴结转移 聚合酶链式反应 

分 类 号：R737.33[医药卫生—肿瘤]